Spinal navigation in cervical fractures--a preliminary clinical study on Judet-osteosynthesis of the axis

To evaluate the accuracy of CT-based and computer-aided screw insertion into the pedicles of the axis using the method of Judet. Materials and Methods In two patients, four transpedicular implants of C2 were positioned using a computer-guided technique. One patient with iatrogenic destabilization of the posterior structures C3 and C4 and one patient with a hangman's fracture of the axis required pedicular fixation. In addition, intraoperative documentation of the additional time required for the navigation procedures was made. Finally, postoperative CTs of each patient provided further information about transpedicular implant localization.

Image-guided implantation of screws was possible in all scheduled pedicles of the axis. In the postoperative CT scans, none of the inserted screws perforated the medial or lateral pedicle. All screws were accurately positioned within the pedicles, and no anterior perforation of the screws into the vertebral foramen was observed.

Our initial results using computer-aided implantation of Judet screws showed that these screws were inserted correctly. However, it is important to realize that movements can occur in the vertebral arch and lateral mass during the time between preoperative CT and surgery. This possibility for movement should be taken into account when procedures such as CT-based insertion of image-guided screws into patients with fractures of the isthmus C2 are performed, because damage to neurovascular structures can result. Therefore, this navigation system should only be used by experienced surgeons who can, if necessary, continue the intervention with more conventional techniques. In addition, it is essential that the surgeon have a complete understanding of the principles of the tracking systems to prevent possible misinterpretation of computer-generated information.